Summative Evaluation - Teacher

Form D
JEFFERSON COUNTY PUBLIC SCHOOLS
COMPREHENSIVE TEACHER PERFORMANCE EVALUATION

NAME: Felisha Jackson SCHOOL/LOCATION: Blake Elementary

YEARS OF
ID #: 136557 SERVICE: 4 Years DATE: 4/25/2016

SUBJ./ GRADE LEVEL: 2nd/3rd Split PRINCIPAL/COST CENTER HEAD: Susan Glenn

DATES OF OBSERVATION: 11/13/2015, 2/12/2016, 3/29/2016

A comprehensive evaluation will be made by the evaluator using multiple sources of evidence as
specified in the Certified Evaluation Plan. A narrative is required for any teacher domain rating that
is marked ineffective or developing and the evaluator and teacher must initial all additional pages.
The evaluator may choose to write a narrative for accomplished or exemplary.

PROFESSIONAL PRACTICE STUDENT GROWTH OVERALL PERFORMANCE

+ =
RATING RATING CATEGORY

Domains Ineffective Developing Accomplished Exemplary

1. Planning and Preparation x
2. Classroom Environment x
3. Instruction x
4. Professional Responsibilities x

The overall professional practice rating is a holistic rating of performance, combining data
from multiple sources of evidence across each domain of the Kentucky Framework for Teaching.

Ineffective Developing Accomplished Exemplary

Professional Practice Rating x

Low Expected High

Overall Student Growth Rating
x

Overall Performance Ineffective Developing Accomplished Exemplary

Category x

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 Summative Evaluation - Teacher
Form D
PROFESSIONAL GROWTH PLAN AND SUMMATIVE CYCLE FOR TEACHERS AND OTHER PROFESSIONALS
If Professional and, if Student
Practice Rating is Growth Rating is
this: this: then: and then this:
Goals set by teacher with evaluator input.
Plan activities are teacher directed and implemented with colleagues.
High or Expected 3 yr. self-directed cycle
Formative review annually.
Exemplary or
Summative occurs at the end of year 3.
Accomplished Goal set by teacher with evaluator input.
Low 3 yr. self-directed cycle One goal must focus on low student growth outcome.
Formative review annually.
Goal(s) set by educator with evaluator input.
High 3 yr. self-directed cycle
Formative review annually.
Goal(s) set by teacher with evaluator input; one must address
Expected 3 yr. self-directed cycle professional practice or student growth.
Developing Formative review annually.
Goal(s) determined by evaluator.
Goals focus on professional practice and student growth.
Low 1 yr. directed cycle
Plan activities designed by evaluator with teacher input.
Summative review annually.
Goal determined by evaluator.
Goals focused on low performance/outcome area.
High or Expected 1 yr. directed cycle Plan activities designed by evaluator with educator input.
Formative review at midpoint.
Ineffective
Summative at end of plan.
Goal(s) determined by evaluator.
Up to 12 month
Low Focus on low performance area.
improvement plan
Summative at end of plan.

Next Steps for Professional Growth Plan and Summative Cycle:

( x ) 3 Year Self-Directed Cycle
( ) 1 Year Directed Cycle
( ) Improvement Plan
3 6 9 12 months
Next Steps: Mrs. Jackson met her Professional Growth Plan goal (4d:
Participating in a Professional Community). She will continue to improve
participation in professional learning communities as a way to refine
instructional next steps for each student. In addition, she will work towards
more student-directed discussions and student self-assessment.

Optional Comments by Evaluator and/or Teacher:

(May be attached to this form provided the evaluator and teacher have initialed all additional pages.)

The teacher may submit a written response within ten (10) days to be sent to Employee Relations for inclusion in the teacher's personnel file
with a copy to the evaluator. Certified personnel have the right to appeal to a JCPS Local Evaluation Appeals Panel (LEAP) within fourteen
(14) calendar days after receiving a summative evaluation. Appeals must be submitted in writing to the superintendent/designee using the
JCPS Certified Evaluation Appeals Form. Appeals to a LEAP may be based upon evaluation process or evaluation content concerns.

DATE EVALUATOR DATE EMPLOYEE

PRINCIPAL/COST CENTER HEAD

Distribution: Personnel File
Principal
Employee

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 Summative Evaluation - Teacher
Form D
Domain 1: Planning and Preparation

1A: Demonstrating Knowledge of Content and Pedagogy

1B: Demonstrating Knowledge of Students
1C: Setting Instructional Outcomes
1D: Demonstrating Knowledge of Resources
1E: Designing Coherent Instruction
1F: Designing Student Assessment

Summary statement:

Not applicable

Domain 2: Classroom Environment

2A: Creating an Environment of Respect and Rapport

2B: Establishing a Culture for Learning
2C: Managing Classroom Procedures
2D: Managing Student Behavior
2E: Organizing Physical Space

Summary statement:

Not applicable

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 Summative Evaluation - Teacher
Form D
Domain 3: Instruction

3A: Communicating with Students

3B: Questioning and Discussion Techniques
3C: Engaging Students in Learning
3D: Using Assessment in Instruction
3E: Demonstrating Flexibility and Responsiveness

Summary statement:

Not applicable

Domain 4: Professional Responsibilities

4A: Reflecting on Teaching

4B: Maintaining Accurate Records
4C: Communicating with Families
4D: Participating in a School Community
4E: Growing and Developing Professionally
4F: Demonstrating Professionalism

Summary statement:

Not applicable

(Rev. 6/2015) FORM D Teacher Page 4 of 4